GeoPrism Registry (Lao PDR)

The deployment of GeoPrism Registry as part of a wider governance structure around geographic information management reduces duplication of data management efforts, and ensures all public health programs rely on the same accurate and current geographic information for their decision making, either directly from the platform or through integrated digital health systems.

Most of Lao PDR’s public health goals have a strong geographical component, and therefore rely on geographic information. Yet, programs across the health sector often use multiple data sources for geographic information (e.g., villages, warehouses, health facilities, and administrative divisions), each having different locations, boundaries and names, as standardized datasets are not always available. This leads to duplicative efforts, inconsistent analyses, and doubts on data validity, and ultimately to delays in programmatic decision-making.

A common geo-registry (CGR) is a digital solution providing a single source of truth for the standardization, management, and use of geographic information over time. It is used to store and manage master lists, their associated geospatial data and hierarchies, and the historical changes in this information, and share this across multiple information systems. Listed as an OpenHIE reference facility registry technology, the open-source GeoPrism Registry is the first platform to implement the CGR specification, and can be fully integrated with DHIS2, Reveal and FHIR, as well as with other systems through a REST API. Realizing the benefits of implementing such a solution, especially with its role as a facility registry in the OpenHIE-based digital health architecture the country is working toward, the Lao Ministry of Health partnered with the Clinton Health Access Initiative, the Health GeoLab Hub, TerraFrame and Vital Wave from 2020 to 2022 to implement the CGR concept and GeoPrism Registry platform.

To ensure the sustainability of Lao PDR’s national CGR, the implementation followed the Health Information Systems Geo-enabling Framework recommendation to include the following components beyond just deploying the technology:

• Situational assessment – Gaining a better understanding of the geographic information landscape across sectors and highlighting any major gaps that would need to be addressed
• Standardization of common geographic information, including master lists, geospatial data, and hierarchies
• Improving the institutional framework for (geographic) information management including establishing coordination mechanisms, SOPs, and supportive policies
• Ensuring centralized access to standardized data by stakeholders through deployment of GeoPrism Registry and integration into digital health architecture
• Building technical capacity in geospatial management, visualization, and analysis across the government to enable programmatic analysis for various use cases

As of 2023, the health facility master list, administrative division lists (country, province, and district boundaries) and medical warehouse master list are hosted in GeoPrism Registry and synchronized with the DHIS2-based national Health Management Information System (HMIS). GeoPrism Registry use has also been scaled up to the provincial level, with at least 3 technical staff of all 18 Provincial Health Offices trained on the health facility master list update mechanism through the platform, coupled with geospatial data collection best practices.

As a result of adopting this refined update mechanism, more than 95% of all health facilities now have accurate geographic coordinates compared to only 43% before. These improved geographic coordinates have led to previously missed or inaccurately geolocated health facilities now being included/correctly displayed in map-based analyses in DHIS2 for e.g., malaria surveillance, and allowed for more advanced spatial analyses to be conducted, such as health facility physical accessibility analyses with AccessMod and QGIS to support immunization microplanning on Oudomxai and Champasak Provinces, and location-based health center investment planning by the Department of Planning and Finance.

In 2023, to further promote digital sovereignty and Lao MoH ownership of GeoPrism Registry, additional capacity building and IT infrastructure investment were done to transition the platform from cloud hosting to local MoH server hosting.

With its advanced (geographic) data management functionality, GeoPrism Registry complements other digital health systems, serving as a single source of truth for lists of geographic information core to public health, which are traditionally managed in programmatic and technological silos. When integrated into the digital health ecosystem through direct integrations (e.g., DHIS2, Reveal) or linkages through its REST API, all digital health systems can benefit from its unique:

• Handling of multiple hierarchies between geographical features, for example a village both belonging to an administrative division and a health catchment area
• Storage of changes over time in attribute values, geospatial data (coordinates and polygons) and hierarchies
• Advanced permissions so the groups with the mandate over specific geographic objects can manage their data separately, while still using the same platform

As such, GeoPrism Registry forms a key building block in the national digital health architecture, ensuring all health programs make their decisions based on the same geographic information.